Comparison of Outcomes of Total Hip Arthroplasty to Hemiarthroplasty for Geriatric Hip Fractures: A Literature Review of Large Database Studies

2018 ◽  
Vol 02 (01) ◽  
pp. 033-046
Author(s):  
Monique Haynes ◽  
Jonathan Grauer
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Multivariable Analysis ◽  
Large Database ◽  
Improvement Program ◽  
National Hospital Discharge Survey ◽  
Total Hip ◽  
Geriatric Hip Fracture

AbstractThe objective of this article is to review large database comparisons of total hip arthroplasty (THA) to hemiarthroplasty (HA) for geriatric hip fracture patients. This article followed a systematic review of the literature using published studies identified via PubMed as the data source. A literature search was done iteratively with a systematic use of variations of key search terms. The initial search identified 490 references. Of the 490, 15 full-text papers were reviewed. Ultimately, nine papers were included in the review. Five of the included studies utilized the National Surgical Quality Improvement Program database, one utilized Hospital Episode Statistics, one utilized The National Hospital Discharge Survey, one utilized Swedish Nation Hip Fracture/Arthroplasty Register, and the last utilized the ENCLAVE system of the Centers for Medicare & Medicaid Services. These all included data ranging from 2005 to 2013 and included at least 1,000 patients. Clinical postoperative outcomes of THA and HA were grouped and compared among the nine studies. The studies used multivariable analysis to make comparisons, and it is of note that HA is much more common than THA in this patient population. Primary outcome variables evaluated included major/minor complications, mortality, length of stay, postoperative transfusion, readmission, dislocation, and revision. Overall, major and minor adverse events (or a combination of the two) were lower for THA than for HA patients, and postoperative transfusions were more common for THA patients. Mortality was significantly less for THA patients by 3% to 4%. Length of stay was lower for THA patients. Dislocation rates were higher for THA patients at 30 days, 18 months, 24 months, and 4 years by odds ratios of three to five times. One study found THA patients more likely to undergo reoperation. In select geriatric patients with femoral neck fractures, THA and HA may be appropriately considered. For those patients, studies suggest that THA may be associated with fewer postoperative challenges than HA; however, postoperative transfusion and dislocation rates were noted to be higher for THA patients.

Malnutrition increases the 30-day complication and re-operation rates in hip fracture patients treated with total hip arthroplasty

2019 ◽  
Vol 30 (5) ◽  
pp. 635-640
Author(s):  
Jared M Newman ◽  
Nipun Sodhi ◽  
Anton Khlopas ◽  
Nicolas S Piuzzi ◽  
George A Yakubek ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Propensity Scores ◽  
Improvement Program ◽  
Surgical Quality ◽  
Total Hip ◽  
Data Regression ◽  
Increased Risk ◽  
Preoperative Albumin

Introduction: This study sought to determine the effect that malnutrition, defined as hypoalbuminemia, has on hip fracture patients treated with total hip arthroplasty (THA). Specifically, we evaluated: (1) demographics and perioperative data; (2) postoperative complications; and (3) re-operation rates. Methods: The National Surgical Quality Improvement Program database was utilised to identify hip fracture patients who underwent THA from 2008 to 2015. Propensity scores were calculated for the likelihood of having a preoperative albumin measurement. Hip fracture patients who underwent THA and had preoperative hypoalbuminemia (<3.5 g/dL) ( n = 569) were compared to those who had normal albumin levels (⩾3.5 g/dL) ( n = 1098) in terms of demographics and perioperative data. Regression models were adjusted for age, sex, modified Charlson/Deyo scores, and propensity scores to evaluate complication and re-operation rates. Results: Compared to controls, hypoalbuminemia patients were older (p = 0.006), more likely male ( p = 0.024), had higher Charlson/Deyo scores ( p = 0.0001), more likely smokers ( p < 0.0001), more likely functionally dependent ( p < 0.0001), had ASA scores ⩾3 ( p < 0.0001) and had longer LOS ( p < 0.0001). Compared to controls, hypoalbuminemia patients had 80% higher risk for any complication (OR = 1.80; 95% CI, 1.43–2.26), 113% higher risk for major complications (OR = 2.13; 95% CI, 1.31–3.48), and 79% higher risk for minor complications (OR = 1.79; 95% CI, 1.42–2.26), and 97% increased risk for re-operation (OR = 1.97; 95% CI, 1.20–3.23). Conclusions: The findings in the present study indicate the need to develop better pre- and postoperative medical and nutritional care for malnourished hip fracture patients who undergo THA in order to potentially mitigate their increased risk.

scholarly journals Predicting life expectancy after geriatric hip fracture: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261279
Author(s):  
Alexander Lee ◽  
Sara Weintraub ◽  
Ianto Lin Xi ◽  
Jaimo Ahn ◽  
Joseph Bernstein
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Life Expectancy ◽  
Hip Arthroplasty ◽  
Survival Data ◽  
Sufficient Information ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
Geriatric Hip Fracture

Background Displaced femoral neck fractures in geriatric patients are typically treated with either hemiarthroplasty or total hip arthroplasty. The choice between hemiarthroplasty and total hip arthroplasty requires a good estimate of the patient’s life expectancy, as the recent HEALTH trial suggests that the benefits of the two operations do not diverge, if at all, until the second year post-operatively. A systematic review was this performed to determine if there sufficient information in the medical literature to estimate a patient’s life expectancy beyond two years and to identify those patient variables affecting survival of that duration. Methods Pubmed, Embase, and Cochrane databases were queried for articles reporting survival data for at least two years post-operatively for at least 100 patients, age 65 or greater, treated surgically for an isolated hip fracture. A final set of 43 papers was created. The methods section of all selected papers was then reviewed to determine which variables were collected in the studies and the results section was reviewed to note whether an effect was reported for all collected variables. Results There were 43 eligible studies with 25 unique variables identified. Only age, gender, comorbidities, the presence of dementia and fracture type were collected in a majority of studies, and within that, only age and gender were reported in a majority of the results. Most (15/ 25) variables were reported in 5 or fewer of the studies. Discussion There are important deficiencies in the literature precluding the evidence-based estimation of 2 year life expectancy. Because the ostensible advantages of total hip arthroplasty are reaped only by those who survive two years or more, there is a need for additional data collection, analysis and reporting regarding survival after geriatric hip fracture.

Perioperative Outcomes of Hemiarthroplasty Versus Total Hip Arthroplasty for Geriatric Hip Fracture: The Importance of Studying Matched Populations

2020 ◽  
Vol 35 (11) ◽  
pp. 3188-3194
Author(s):  
Monique S. Haynes ◽  
Nathaniel T. Ondeck ◽  
Taylor D. Ottesen ◽  
Rohil Malpani ◽  
Lee E. Rubin ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Perioperative Outcomes ◽  
Total Hip ◽  
Geriatric Hip Fracture

Risk Factors for Early Periprosthetic Fracture after Primary Total Hip Arthroplasty

2020 ◽  
Vol 04 (01) ◽  
pp. 038-044
Author(s):  
Wesley M. Durand ◽  
Morteza Meftah ◽  
Ran Schwarzkopf
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Fracture ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Total Hip ◽  
Significant Difference

AbstractPeriprosthetic fracture (PPF) after total hip arthroplasty (THA) is associated with adverse outcomes. Many studies have sought to determine risk factors for PPF, though controversy exists regarding several variables. This study sought to determine risk factors for early PPF using the National Surgical Quality Improvement Program (NSQIP) dataset. Patients with a primary current procedural terminology for THA were identified. The primary outcome was reoperation/readmission for PPF within 30 days. Multivariable logistic regression was utilized to adjust for confounding factors. A total of 159,234 patients were included in the study, of whom 195 patients (0.12%) had a PPF within 30 days, with a mean day of reoperation/readmission of 14.6 (standard deviation 7.7). A total of 68 patients (34.9% of those fractured) underwent one or more reoperations. In multivariable analysis, risk factors for PPF were higher body mass index (BMI; odds ratio [OR] 1.03 per mg/kg2, 95% confidence interval [CI] 1.0–1.05) and higher preoperative leukocyte count (OR 1.04 per 103/mL, 95% CI 1.01–1.06). Among females, age (OR 1.05 per year, 95% CI 1.04–1.07) was significantly associated with PPF, but a similar difference was not observed among males (OR 1.01, 95% CI 0.98–1.04). Controlling for patient age, there was no significant difference in risk of PPF for females versus males (p = 0.2213). PPF was associated with the development of additional complications (OR 4.10, 95% CI 2.68–6.27). This study identified risk factors for PPF after primary THA. These results have implications for preoperative planning and postoperative precautions among patients with particularly elevated risk of PPF.

Effect of operative time on complications following primary total hip arthroplasty: analysis of the NSQIP database

2020 ◽  
pp. 112070002094970
Author(s):  
Mark Sikov ◽  
Matthew Sloan ◽  
Neil P Sheth
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Operative Time ◽  
Complication Rates ◽  
Improvement Program ◽  
Perioperative Morbidity ◽  
Total Hip ◽  
Risk Of Death ◽  
Increased Risk

Background: Long operative times in total hip arthroplasty (THA) have been shown to be associated with increased risk of revision as well as perioperative morbidity. This study assesses the effect of extended operative times on complication rates following primary THA using the most recent national data. Methods: The National Surgical Quality Improvement Program (NSQIP) database (2008–2016) was queried for primary THA. Groups were defined by operative time 1 standard deviation (1 SD) above the mean. Univariate, propensity score-matched, and multivariate logistic regression analyses were performed to evaluate outcomes. Results: Data was available for 135,013 THA patients. Among these groups, mean operative time in the extended operative time group was 166 minutes (compared with 82 minutes). Patients undergoing longer operative times were 3.8 years younger, had a 1.5 kg/m2 higher body mass index and had a 0.5 day longer mean length of stay. Propensity matching identified 16,123 pairs for analysis in the 1 SD group. Longer operative time led to 173% increased risk of major medical morbidity, 140% increased likelihood of length of stay greater than 5 days, 59% increased risk of reoperation, 45% increased risk of readmission, and a 30% decreased likelihood of return to home postoperatively. There was no increased risk of death within 30 days. Conclusion: Long operative times were associated with increases in multiple postoperative complications, but not mortality. Surgeons should be advised to take steps to minimise operative time by adequate preoperative planning and optimal team communication.

Preoperative Hyponatremia is a Risk Factor for Adverse 30-Day Outcomes Following Total Hip Arthroplasty

2020 ◽  
Vol 04 (01) ◽  
pp. 007-014
Author(s):  
Joseph E. Tanenbaum ◽  
Thomas T. Bomberger ◽  
Derrick M. Knapik ◽  
Steven J. Fitzgerald ◽  
Nihar S. Shah ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Improvement Program ◽  
Surgical Quality ◽  
Total Hip

AbstractThe relationship between preoperative hyponatremia and 30-day outcomes following total hip arthroplasty (THA) is currently unknown. The present study used prospectively collected data to quantify the association between preoperative hyponatremia and odds of major morbidity (MM), longer length of stay, readmission, and reoperation within 30 days following THA. Patients who underwent THA between 2012 and 2014 were identified in the National Surgical Quality Improvement Program database using validated Current Procedural Terminology codes. Patients were included if they were either normonatremic or hyponatremic preoperatively. The outcome measures in this study were 30-day MM, hospital length of stay, 30-day readmission, and 30-day reoperation. A unique multivariable logistic regression model was used for each outcome to identify statistically significant associations between hyponatremia and the outcome of interest after adjusting for covariates. From 2012 to 2014, 59,236 THA procedures were recorded in National Surgical Quality Improvement Program, of which 55,611 patients were normonatremic and 3,051 patients were hyponatremic. After adjusting for covariates, preoperative hyponatremia was significantly associated with increased odds of MM (odds ratio [OR] = 1.14; 99% confidence interval [CI]: 1.01–1.30), 30-day reoperation (OR = 1.18; 99% CI: 1.02–1.36), and longer hospital length of stay (OR = 1.20; 99% CI: 1.13–1.27). Hyponatremia was not significantly associated with greater odds of 30-day readmission (OR = 0.91; 99% CI: 0.82–1.01). Preoperative hyponatremia was significantly associated with adverse 30-day outcomes following THA. As the U.S. health care system continues to transition toward value-based reimbursement that emphasizes health care quality, the results of the present study can be used to improve patient selection and preoperative counseling.

scholarly journals Total hip arthroplasty through an anterior approach

2018 ◽  
Vol 3 (11) ◽  
pp. 574-583 ◽  
Author(s):  
Georgios Kyriakopoulos ◽  
Lazaros Poultsides ◽  
Panayiotis Christofilopoulos
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Formal Training ◽  
Long Term Outcomes ◽  
Medium Term ◽  
Total Hip

Total hip arthroplasty through an anterior approach has been increasing in popularity amongst surgeons and patients. Anterior approach hip arthroplasty seems to offer improved early outcomes in terms of pain, rehabilitation and length of stay. No difference in long-term outcomes has been shown between anterior and posterior or lateral approaches. Proper formal training, utilization of fluoroscopy and adequate experience can mitigate risks of complications and improve early and medium-term outcomes. Cite this article: EFORT Open Rev 2018;3:574-583. DOI: 10.1302/2058-5241.3.180023.

scholarly journals Total hip arthroplasty after hip fracture

BMJ ◽  
2016 ◽  
pp. i2217 ◽  
Author(s):  
Harman Chaudhry
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Hip

scholarly journals Is implant sonication useful when screening for infection in conversion of prior hip fracture fixation to total hip arthroplasty?

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110281
Author(s):  
Yannick Palmowski ◽  
Matthias Pumberger ◽  
Carsten Perka ◽  
Sebastian Hardt ◽  
Christian Hipfl
Keyword(s):  
Treatment Outcome ◽  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Fracture Fixation ◽  
Microbiological Analysis ◽  
Total Hip ◽  
Osteosynthesis Material ◽  
Cutibacterium Acnes

Objective To examine sonication results in presumed aseptic conversion total hip arthroplasty (THA) after hip fracture fixation and to evaluate its implications on the treatment outcome. Methods This retrospective cohort study reviewed the data from presumed aseptic patients that underwent conversion of prior internal fixation of proximal femoral fractures to THA between 2012 and 2018. Microbiological analysis was performed using sonication of osteosynthesis material and tissue samples. Treatment outcome including the occurrence of periprosthetic joint infection (PJI) was recorded. Results A total of 32 patients were included in the study. Of these, five patients (15.6%) had positive intraoperative cultures. The mean follow-up following conversion THA was 43.0 months (range, 19.0–91.5 months). Sonication was positive in three patients (9.4%), all of whom were deemed contaminated and did not develop PJI. Tissue cultures were positive in two patients (6.3%). One patient with Enterococcus faecalis received antibiotic treatment and did not develop PJI. Another patient with growth of Cutibacterium acnes that was initially classified as a contaminant later developed acute PJI caused by the same pathogen. Overall, PJI occurred in two patients (6.3%) after conversion THA. Conclusion Sonication of internal fixation devices did not add diagnostic value in clinically aseptic conversion THA. Further studies are needed to better understand the relevance of unexpected positive cultures, and to develop diagnostic criteria for the management of these patients.

scholarly journals Inequalities in access to total hip arthroplasty for hip fracture: a population-based study

The Lancet ◽  
2016 ◽  
Vol 387 ◽  
pp. S81
Author(s):  
Daniel Perry ◽  
David Metcalfe ◽  
Matthew Costa
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Population Based ◽  
Population Based Study ◽  
Total Hip
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